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Consideration of Shared Decision Making in Nursing: A Review of Clinicians’ Perceptions and Interventions

Clark, Noreen M; Nelson, Belinda W; Valerio, Melissa A; Gong, Z. Molly; Taylor-Fishwick, Judith C; Fletcher, Monica
Fonte: Bentham Open Publicador: Bentham Open
Tipo: Artigo de Revista Científica
Publicado em 02/10/2009 EN
Relevância na Pesquisa
66.34%
As the number of individuals with chronic illness increases so has the need for strategies to enable nurses to engage them effectively in daily management of their conditions. Shared decision making between patients and nurses is one approach frequently discussed in the literature. This paper reviews recent studies of shared decision making and the meaning of findings for the nurse-patient relationship. Patients likely to prefer to engage in shared decision making are younger and have higher levels of education. However, there is a lack of evidence for the effect of shared decision making on patient outcomes. Further, studies are needed to examine shared decision making when the patient is a child. Nurses are professionally suited to engage their patients fully in treatment plans. More evidence for how shared decision making affects outcomes and how nurses can successfully achieve such engagement is needed.

Shared Decision Making: A Model for Clinical Practice

Elwyn, Glyn; Frosch, Dominick; Thomson, Richard; Joseph-Williams, Natalie; Lloyd, Amy; Kinnersley, Paul; Cording, Emma; Tomson, Dave; Dodd, Carole; Rollnick, Stephen; Edwards, Adrian; Barry, Michael
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
66.29%
The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences.

SHARED DECISION MAKING FOR CANCER CARE AMONG RACIAL AND ETHNIC MINORITIES: A SYSTEMATIC REVIEW

Mead, Erin L.; Doorenbos, Ardith Z.; Javid, Sara H.; Haozous, Emily A.; Arviso Alvord, Lori; Flum, David R.; Morris, Arden M.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
66.25%
To assess decision making for cancer treatment among racial/ethnic minority patients, we systematically reviewed and synthesized evidence from studies of “shared decision-making,” “cancer,” and “minority groups,” using PubMed, PsycInfo, CINAHL, and EMBASE. We identified significant themes that we compared across studies, refined, and organized into a conceptual model. Five major themes emerged: treatment decision-making, patient factors, family and important others, community, and provider factors. Thematic data overlapped categories, indicating that individuals’ preferences for medical decision-making cannot be authentically examined outside the context of family and community. The shared decision-making model should be expanded beyond the traditional patient–physician dyad to include other important stakeholders in the cancer treatment decision process, such as family or community leaders.

Choosing Wisely and Beyond: Shared Decision Making and Chronic Kidney Disease

Tuso, Phillip
Fonte: The Permanente Journal Publicador: The Permanente Journal
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.27%
In 2012, the Kaiser Permanente Area Medical Directors of Quality decided to sponsor analytic activities to improve shared decision making for patients with chronic kidney disease. The objective was to move shared decision making for renal replacement therapy or maximal conservative management upstream rather than waiting until the patient presented to the emergency room requiring acute dialysis. Nephrologists have multiple opportunities to discuss treatment options with patients throughout the course of their disease. However, despite these opportunities most patients beginning dialysis have not experienced shared decision making with their physicians. The shared-decision-making process may help patients understand the importance of being prepared to start dialysis and the benefits of maximal conservative management.

Core Competencies for Shared Decision Making Training Programs: Insights From an International, Interdisciplinary Working Group

Légaré, France; Moumjid-Ferdjaoui, Nora; Drolet, Renée; Stacey, Dawn; Härter, Martin; Bastian, Hilda; Beaulieu, Marie-Dominique; Borduas, Francine; Charles, Cathy; Coulter, Angela; Desroches, Sophie; Friedrich, Gwendolyn; Gafni, Amiram; Graham, Ian D.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.38%
Shared decision making is now making inroads in health care professionals’ continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training.

Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

Fukui, Sadaaki; Salyers, Michelle P.; Matthias, Marianne S.; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
66.23%
The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.

Deciding Together? Best Interests and Shared Decision-Making in Paediatric Intensive Care

Birchley, Giles
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
66.39%
In the western healthcare, shared decision making has become the orthodox approach to making healthcare choices as a way of promoting patient autonomy. Despite the fact that the autonomy paradigm is poorly suited to paediatric decision making, such an approach is enshrined in English common law. When reaching moral decisions, for instance when it is unclear whether treatment or non-treatment will serve a child’s best interests, shared decision making is particularly questionable because agreement does not ensure moral validity. With reference to current common law and focusing on intensive care practice, this paper investigates what claims shared decision making may have to legitimacy in a paediatric intensive care setting. Drawing on key texts, I suggest these identify advantages to parents and clinicians but not to the child who is the subject of the decision. Without evidence that shared decision making increases the quality of the decision that is being made, it appears that a focus on the shared nature of a decision does not cohere with the principle that the best interests of the child should remain paramount. In the face of significant pressures toward the displacement of the child’s interests in a shared decision, advantages of a shared decision to decisional quality require elucidation. Although a number of arguments of this nature may have potential...

“Appropriate” diagnostic testing: supporting diagnostics with evidence-based medicine and shared decision making

Polaris, Julian JZ; Katz, Jeffrey N
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
96.23%
Background: Evidence-based medicine is an important approach to avoiding care that is unlikely to benefit patients in both the treatment and the diagnostic context. The medical evidence alone may not determine the most appropriate care decision. Patient interests are best served when the advantages and risks of a diagnostic test are viewed through the lens of the patient’s values. That is, the paradigm of evidence-based medicine should be complemented by the paradigm of shared decision making. Analysis Diagnostic testing may offer physiological and psychological benefits. Clinicians should also discuss the potential harms, however, which may be physiological (e.g. radiation or scarring), psychological (e.g. anxiety), and financial (e.g. cost-sharing burdens). All three of these concerns are compounded by the risk of false positives or incidental findings that are not serious, but which require decisions about further testing or treatment. Conclusion: We suggest that patient-centered decision making around diagnostic testing involves a two-step inquiry: Is the test medically appropriate? Does the available evidence documenting short- and long-term risk and benefits support the test for its intended use, given the patient’s characteristics and symptoms?Is the test appropriate for this patient? Has the provider initiated a conversation about tradeoffs that helps the patient evaluate whether the balance of risks and benefits is consonant with the patient’s own values and preferences? Potential benefits and harms to consider include the physiological...

Can shared decision-making reduce medical malpractice litigation? A systematic review

Durand, Marie-Anne; Moulton, Benjamin; Cockle, Elizabeth; Mann, Mala; Elwyn, Glyn
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
96.37%
Background: To explore the likely influence and impact of shared decision-making on medical malpractice litigation and patients’ intentions to initiate litigation. Methods: We included all observational, interventional and qualitative studies published in all languages, which assessed the effect or likely influence of shared decision-making or shared decision-making interventions on medical malpractice litigation or on patients’ intentions to litigate. The following databases were searched from inception until January 2014: CINAHL, Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, HMIC, Lexis library, MEDLINE, NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge. We also hand searched reference lists of included studies and contacted experts in the field. Downs & Black quality assessment checklist, the Critical Appraisal Skill Programme qualitative tool, and the Critical Appraisal Guidelines for single case study research were used to assess the quality of included studies. Results: 6562 records were screened and 19 articles were retrieved for full-text review. Five studies wee included in the review. Due to the number and heterogeneity of included studies, we conducted a narrative synthesis adapted from the ESRC guidance for narrative synthesis. Four themes emerged. The analysis confirms the absence of empirical data necessary to determine whether or not shared decision-making promoted in the clinical encounter can reduce litigation. Three out of five included studies provide retrospective and simulated data suggesting that ignoring or failing to diagnose patient preferences...

Dying cancer patients talk about physician and patient role in DNR decision making

Eliott, J.; Olver, I.
Fonte: Wiley-Blackwell Publishing Ltd Publicador: Wiley-Blackwell Publishing Ltd
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
76.12%
Background:  Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Objective:  Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Design and participants:  Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Results:  Participants’ descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants’ endorsement of physicians as decision makers rested upon physicians’ enactment of the rational...

Medical decision-making, adherence and quality of life in people living with HIV/AIDS; Therapieentscheidung, Adhärenz und Lebensqualität von Menschen mit HIV/AIDS

Kremer, Heidemarie
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
EN
Relevância na Pesquisa
76.31%
Introduction: The purpose of this study is to describe the decision about antiretroviral therapy (ART) from the perspective of people living with HIV/AIDS (PWHA) and to develop models to reduce decisional conflict and to optimize the quality of life in PWHA. Methods: 79 HIV+ people who had been offered ART by their physicians participated. In the qualitative part of this study, interviews on reasons and sources of information for decision-making and patient-physician relationship were evaluated with qualitative content analysis. In the quantitative part of this study, questionnaires examined preferred and perceived role in decision-making (Control Preferences Scale), decisional conflict (Decisional Conflict Scale), adherence and symptoms of HIV/ART (ACTG Adherence Questionnaire), quality of life (HIV/AIDS Targeted Quality of Life), depression (Beck Depression Inventory), perceived stress (Perceived Stress Scale), patient-physician relationship (Doctor-Patient Relationship) and beliefs about medicines (Beliefs about Medicines Questionnaire). Results: Qualitative: Seventy-three percent decided to take ART, and 27% decided not to take ART. Ten criteria were important: Surrogate markers (87%), quality of life (85%), knowledge/beliefs about resistance (66%)...

Shared decision-making in the context of unruptured intracranial aneurysms management

Castro-Afonso,Luís Henrique de; Abud,Daniel Giansante
Fonte: Academia Brasileira de Neurologia - ABNEURO Publicador: Academia Brasileira de Neurologia - ABNEURO
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2015 EN
Relevância na Pesquisa
96.25%
Shared decision-making practice has been encouraged in several clinical settings. In this model, clinical decisions are defined by doctors and patients based on the principle of patient autonomy. Shared decisions have been argued as an ethical clinical practice during complex and uncertain clinical situations. The best management of unruptured intracranial aneurysms (UIA) remains controversial. Despite the fact that shared decisions has probably been practiced, as far as we are aware it has not yet been evaluated, nor has it been standardized for patients presenting UIA. We aim to discuss possible roles, pros and cons of shared decision-making on the management of UIA.

Details for Manuscript Number: SSM-D-08-01910 R2 “Race and Shared Decision-Making: Perspectives of African-Americans with Diabetes”

Peek, Monica E.; Odoms-Young, Angela; Quinn, Michael T; Gorawara-Bhat, Rita; Wilson, Shannon C; Chin, Marshall H
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
66.29%
Shared decision-making (SDM) is an important component of patient-centered healthcare and is positively associated with improved health outcomes (e.g. diabetes and hypertension control). In shared decision-making, patients and physicians engage in bidirectional dialogue about patients' symptoms and treatment options, and select treatment plans that address patient preferences. Existing research shows that African-Americans experience SDM less often than whites, a fact which may contribute to racial disparities in diabetes outcomes. Yet little is known about the reasons for racial disparities in shared decision-making. We explored patient perceptions of how race may influence SDM between African-American patients and their physicians. We conducted in-depth interviews (n=24) and five focus groups (n= 27) among a purposeful sample of African-American diabetes patients aged over 21 years, at an urban academic medical center in Chicago. Each interview/focus group was audio-taped, transcribed verbatim and imported into Atlas.ti software. Coding was conducted iteratively; each transcription was independently coded by two research team members. Although there was heterogeneity in patients' perceptions about the influence of race on SDM, in each of the SDM domains (information-sharing...

Patient Trust in Physicians and Shared Decision-Making Among African-Americans With Diabetes

Peek, Monica E.; Gorawara-Bhat, Rita; Quinn, Michael T.; Odoms-Young, Angela; Wilson, Shannon C.; Chin, Marshall H.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
66.21%
This study explores patient trust in physicians and its relationship to shared decision-making (SDM) among African-Americans with diabetes (types 1 and 2). We conducted a series of focus groups (n = 27) and in-depth interviews (n = 24). Topic guides were developed utilizing theoretical constructs. Each interview was audiotaped and transcribed verbatim. Each transcript was independently coded by two randomly assigned members of the research team; codes and themes were identified in an iterative fashion utilizing Atlas.ti software. The mean age of study participants was 62 years and 85% were female. We found that (1) race as a social construct has the potential to influence key domains of patient trust (interpersonal/relationship aspects and medical skills/technical competence), (2) the relationship between patient trust and shared decision-making is bidirectional in nature, and (3) enhancing patient trust may potentially increase or decrease SDM among African-Americans with diabetes. Mistrust of physicians among African-Americans with diabetes may partially be addressed through (1) patient education efforts, (2) physician training in interpersonal skills and cultural competence, and (3) physician efforts to engage patients in SDM. To help enhance patient outcomes among African-Americans with diabetes...

Shared decision making in mental health: prospects for personalized medicine

Drake, Robert E.; Cimpean, Delia; Torrey, William C.
Fonte: Les Laboratoires Servier Publicador: Les Laboratoires Servier
Tipo: Artigo de Revista Científica
Publicado em /12/2009 EN
Relevância na Pesquisa
66.31%
This paper describes the shared decision-making model, reviews its current status in the mental health field, and discusses its potential impact on personalized medicine. Shared decision making denotes a structured process that encourages full participation by patient and provider. Current research shows that shared decision making can improve the participation of mental health patients and the quality of decisions in terms of knowledge and values. The impact of shared decision making on adherence, illness self-management, and health outcomes remains to be studied. Implementing shared decision making broadly will require re-engineering the flow of clinical care in routine practice settings and much greater use of information technology Similar changes will be needed to combine genomic and other biological data with patients' values and preferences and with clinicians' expertise. The future of personalized medicine is dearly linked with our ability to create the infrastructure and cultural receptivity to these changes.

The role of nurses and patients' involvement in the clinical decision-making process

Campos,Diana Catarina Ferreira de; Graveto,João Manuel Garcia do Nascimento
Fonte: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Publicador: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2009 EN
Relevância na Pesquisa
76.2%
This paper is a literature review based on articles in the nursing field about shared clinical decision. The objectives are to examine the role of nurses and patients in the decision-making process in the context of clinical practice. To support these themes, a review of recent literature was conducted with the following results: patients prefer shared decision-making with professionals who should support and provide information to patients in order to overcome the barriers hampering patients' involvement in decision-making. There is a clear need for more research studies that address the problems in the clinical decision-making process so as to contribute to healthcare improvement.

“Is there somebody who’s willing to hold their hand at the edge?” - Bringing the Patient to the Center of Physician-Patient Communication and Decision-Making on Bone Marrow Transplantation

Chhabra, Karan
Fonte: Universidade Duke Publicador: Universidade Duke
Publicado em 04/04/2011 EN_US
Relevância na Pesquisa
76.09%
Medicine is beginning to appreciate the value of “patient-centeredness”—healthcare attentive to the unique characteristics, needs, and values of each patient—and a wide body of evidence shows that physician-patient dynamics can have real effects on patients’ health. The patient-centeredness movement has led to calls for more equitable physician-patient relationships, shared decision-making, and more individualized models of care. But building all those requires fundamental shifts in the language physicians use to communicate. I analyzed 20 conversations between patients and physicians specializing in bone marrow transplantation for the physician-patient relationships that their communication produces, and the effect of those relationships on patients’ decision-making ability. My findings revolved around the “data dump”—that is, the physician’s nearly ubiquitous, depersonalized, extended monologue on the biology and history of the patient’s disease, the array of options available to treat it, and the risks and prognosis associated with each. I found that “data dumping” can have one of two effects: leaving patients confused and unable to decide on a treatment path, or silencing patients and preventing them from actively choosing their treatment. Silencing and disempowering patients can in turn prevent them from voicing clinically relevant information...

Papel do enfermeiro e envolvimento do cliente no processo de tomada de decisão clínica; Papel del enfermero y participación del cliente en el proceso de toma de decisiones clínicas; The role of nurses and patients' involvement in the clinical decision-making process

Campos, Diana Catarina Ferreira de; Graveto, João Manuel Garcia do Nascimento
Fonte: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto Publicador: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf; application/pdf; application/pdf
Publicado em 01/12/2009 ENG; POR; SPA
Relevância na Pesquisa
76.22%
O presente trabalho é de revisão de literatura, baseada em artigos de investigação da área da enfermagem, abordando o tema: decisão clínica partilhada. Os objetivos estão direcionados para o analisar do papel do enfermeiro e do paciente no processo de tomada de decisão em contextos da prática clínica. Para fundamentar essas temáticas, fez-se revisão de literatura recente que revelou os seguintes resultados: os pacientes preferem partilhar a tomada de decisão com os profissionais e os profissionais devem apoiar e dar informação aos clientes de forma a diluir as barreiras que dificultam o seu envolvimento no processo de decisão. Ficou clara a necessidade de mais estudos que evidenciem problemáticas no processo de decisão em contexto clínico, no sentido de contribuir para a evolução dos cuidados.; El presente trabajo es de revisión de literatura, está basado en artículos de investigación del área de enfermería, abordando el tema: decisión clínica compartida. Los objetivos fueron dirigidos a analizar el papel del enfermero y del paciente en el proceso de la toma de decisiones en contextos de la práctica clínica. Para fundamentar esas temáticas, se hizo una revisión de la literatura reciente, la que reveló los siguientes resultados: los pacientes prefieren compartir la toma de decisiones con los profesionales y los profesionales deben apoyar y dar información a los clientes de forma a diluir las barreras que dificultan su participación en el proceso de decisión. Quedó clara la necesidad de realizar más estudios que presenten evidencias problemáticas en el proceso de decisión en el contexto clínico...

Informed shared decision making: An exploratory study in pharmacy

Kassam,Rosemin; Volume-Smith,Carlyn; Albon,Simon P.
Fonte: Pharmacy Practice (Internet) Publicador: Pharmacy Practice (Internet)
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/06/2008 ENG
Relevância na Pesquisa
86.07%
Introduction: A study was undertaken to examine the feasibility of using the physician-based Informed Shared Decision Making (ISDM) framework for teaching pharmacy students competencies to effectively develop therapeutic relationships with patients. Objectives: To: (1) assess the relevance and importance of the physician-developed ISDM competencies for pharmacy practice, (2) determine which competencies would be easiest and hardest to practice, (3) identify barriers to implementing ISDM in pharmacy practice, and (4) identify typical situations in which ISDM is or could be practiced. Methods: Twenty pharmacists representing 4 different practices were interviewed using a standardized interview protocol. Results: Pharmacists acknowledged that majority of the physician-based competencies were relevant to pharmacy practice; although not all competencies were considered to be most important. Competency #1 (Develop a partnership with the patient) was found to be the most relevant, the most important and the easiest to practice of all the competencies. While no one competency was identified as being hard to practice, there were several barriers identified to practicing ISDM. Finally, pharmacists expressed that patients with chronic conditions would be the most ideal for engaging in ISDM. Conclusion: While pharmacists believed that the ISDM model could provide a framework for pharmacists to develop therapeutic relationships with their patients...

Shared Decision Making in Breast Cancer Womens' Attitudes

Martín-Fernández,Roberto; Abt-Sacks,Analía; Perestelo-Perez,Lilisbeth; Serrano-Aguilar,Pedro
Fonte: Ministerio de Sanidad y Consumo Publicador: Ministerio de Sanidad y Consumo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2013 EN
Relevância na Pesquisa
86.16%
Background: The patient autonomy and the greater role for women with breast cancer in the decisions about their health are recent issues in healthcare. The objective of this work is to identify and characterize the elements that influence them in treatment decisions. Methods: A phenomenological type qualitative study. Theoretical Sampling included 70 women diagnosed with breast cancer. 45 semi structured interviews and 3 focus groups were performed between October 2009 and July 2010 in 15 regions of Spain. The analysis was based on the principles of grounded theory with the support of Atlas.ti v6.1. Results: Patients are likely to take an active or passive role regarding decision-making depending on different variables such as their age, the information available, their self-assessment as capable agents to make decisions and the relative importance given to physical appearance. As the disease progresses, it can cause a change in women attitude, from an initially passive attitude to a more active role. The attitude of health professionals concerning shared decision-making and the information they offer determines patient participation while the family plays an essential role as a support or reinforcement of decisions made by patients. Conclusions: The patients' attitude regarding the decision-making of patients is very variable...